Bolio-Cerdán A, Ruiz-González S, Romero-Cárdenas P, Hernández-Morales G, Villasís-Keever MÁ

Language: Spanish
References: 22
Page: 151-158
PDF size: 329.36 Kb.

ABSTRACT

Background. At the present time, the Fontan procedure is indicated for patients with univentricular cardiac pathology. In Mexico, few tertiary centers are performing Fontan surgery in the pediatric population. The objective of this study was to analyze the results of patients with congenital heart disease with univentricular physiology who have undergone Fontan surgery since 1980 in the Hospital Infantil de México Dr. Federico Gómez.
Methods. We present a retrospective analysis of pediatric patients undergoing Fontan surgery. We included variables related to preoperative mortality and morbidity along with those related to surgery and to the postoperative period. A bivariate analysis with the comparison of averages and odds ratio was performed. Kaplan-Meier survival curves were constructed.
Results. From 1983 to 2012, 53 Fontan surgeries have been performed. Of the total, comprehensive data of 32 patients were gathered. The most common congenital heart anomaly was tricuspid atresia IB (39.4%). According to type of surgery, in 48% of patients extracardiac Fontan was performed followed by intracardiac Fontan (24%). In 87% of patients fenestration was performed. The most common complications were acute renal failure, neurological problems and pleural effusion. Overall survival was 65.6%; 90.9% of patients died within the first month of surgery. Patients have been reported with ›20 years of survival (average actuarial survival 14.5 years). Variables associated with mortality were younger age at surgery, type of Fontan performed, surgical technique complications, lack of fenestration and acute renal failure.
Conclusions. Evolution of Fontan surgery during the past 30 years has been satisfactory. In patients undergoing this procedure, mortality and quality of life have shown improvements

REFERENCES

1. Argüello C, De la Cruz MV, Gómez CS. Experimental study of the formation of the heart tube in the chick embryo. J Embriol Exp Morphol 1975;33:1-11.

2. Jonas RA. Indications and timing for bidirectional Glenn shunt versus the fenestrated Fontan circulation. J Thorac Cardiovasc Surg 1994;108:522-524.

3. Castañeda AR. From Glenn to Fontan. A continuing evolution. Circulation 1992;86(suppl 2):80-84.

4. Calderón-Colmenero JC, Ramírez S, Viesca R, Ramírez L, Casanova M, García-Montes JA, et al. Cirugía de Fontan. Factores de riesgo a corto y mediano plazo. Arch Cardiol Mex 2005;75:425-434.

5. Jonas RA, DiNardo JA. Comprehensive Surgical Management of Congenital Heart Disease. London: Arnold/Oxford University Press; 2004.

6. Choussat A, Fontan F, Besse P. Selection criteria for Fontan’s procedure. En: Anderson RH, Shinebourn EA. Pediatric Cardiology. Edinburgh: Churchill Livingstone, 1978. pp. 559-566.

7. Gentles TL, Mayer JE Jr, Gauvreau K, Newburger JW, Lock JE, Kupferschmid JP, et al. Fontan operation in five hundred consecutive patients: factors influencing early and late outcome. J Thorac Cardiovasc Surg 1997;114:376-391.

8. Knott-Craig CJ, Danielson GK, Schaff HV, Puga FJ, Weaver AL, Driscoll DD. The modified Fontan operation. An analysis of risk factors for early postoperative death or takedown in 702 consecutive patients from one institution. J Thorac Cardiovasc Surg 1995;109:1237-1243.

9. Gentles TL, Gauvreau K, Mayer JE Jr, Fishberger SB, Burnett J, Colan SD, et al. Functional outcome after the Fontan operation: factors influencing late morbidity. J Thorac Cardiovasc Surg 1997;114:392-403.

10. Mayers JE Jr, Bridges ND, Lock JE, Hanley FL, Jonas RA, Castaneda AR. Factors associated with marked reduction in mortality for Fontan operations in patients with single ventricle. J Thorac Cardiovasc Surg 1992;103:444-451.

11. Marcelleti CF, Hanley FL, Mavroudis C, McElhinney DB, Abella RF, Marianeschi SM, et al. Revision of previous Fontan connections to total extracardiac cavopulmonary anastomosis: a multicenter experience. J Thorac Cardiovasc Surg 2000;119:340-346.

12. Ilbawi MN, Idriss FS, Muster AJ, DeLeon SY, Berry TE, Duffy CE, et al. Effects of elevated coronary sinus pressure on left ventricular function after the Fontan operations. An experimental and clinical correlation. J Thorac Cardiovasc Surg 1986;92:231-237.

13. Laks H, Hass GS, Pearl MJ y cols. The use of an adjustable intraatrial communication in patients undergoing the Fontan and other definitive heart procedures. Abstract. Circulation 1988;78(suppl II):357.

14. Cassalett G, Carrillo G, Caicedo V, Orjuela H, Santos H, Sandoval N. Cirugía de Fontan a la altura de Bogotá. Rev Col Cardiol 1993;4:106.

15. Pizarro C, De Leval MR. Surgical variations and flow dynamics in cavopulmonary connections. A historical review. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998;1:53-60.

16. Salim MA, DiSessa TG, Arheart KL, Alpert BS. Contribution of superior vena caval flow to total cardiac output in children. A Doppler echocardiographic study. Circulation 1995;92:1860-1865.

17. Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax 1971;26:240-248.

18. Kreutzer G, Galíndez E, Bono H, De Palma C, Laura JP. An operation for the correction of tricuspid atresia. J Thorac Cardiovasc Surg 1973;66:613-621.

19. Giglia TM, Humpl T. Preoperative pulmonary hemodynamics and assessment operability: is there a pulmonary vascular resistance that precludes cardiac operation? Pediatr Crit Care 2010;11(suppl 2):S57-S69.

20. Bridges ND, Lock JE, Castaneda AR. Baffle fenestration with subsecuent transcatheter closure. Modification of the Fontan operation for patients at increased risk. Circulation 1990;82:1681-1689.

21. Bridges ND. Fenestration of the Fontan baffle. Benefits and complications. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 1998;1:9-14.

22. Khairy P, Fernandes SM, Mayer JE Jr, Triedman JK, Walsh EP, Lock JE, et al. Long-term survival, modes of death, and predictors of mortality in patients with Fontan surgery. Circulation 2008;117:85-92.